Individual provider Active NPI

Alexzandria Dwan Marotta, ARNP

  • Nurse Practitioner
  • Lady Lake, FL
National Provider Identifier
1073895439
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP9356337 Issued in FL
Practice address
1400 N US Highway 441 Ste 540
Lady Lake, FL 32159-8987
Phone
(352) 753-9777
Fax
(352) 753-9781
NPI assigned
Sep 12, 2011
Last updated
Oct 27, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9356337 FL
Nurse Practitioner 363L00000X ARNP9356337 FL Primary

Addresses

Primary practice location

1400 N US Highway 441 Ste 540
Lady Lake, FL 32159-8987

Mailing address

PO Box 102222
Attn: Credentialing Dept.
Atlanta, GA 30368-2222
Phone (239) 274-8200

Other identifiers 1

IdentifierTypeStateIssuer
008358400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130606000357 FL Practitioner - Nurse Practitioner 6305084179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3840 Broadway
Fort Myers, FL 33901-8108
Phone (239) 275-6400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Cancer Specialists & Research Institute, LLC CurrentSince Apr 1, 2013 Accepting new patients
Florida Cancer Specialists & Research Institute, LLC Past Accepting new patients

Locations

3840 Broadway
Fort Myers, FL 33901
Phone (239) 275-6400

4371 Veronica S Shoemaker Blvd
Fort Myers, FL 33916
Phone (239) 432-8500

4100 Waterman Way
Tavares, FL 32778
Phone (352) 343-1117

1400 N US Highway 441
Ste 540
The Villages, FL 32159
Phone (352) 561-3290

1400 N US Highway 441
Ste 552
The Villages, FL 32159
Phone (352) 751-2862

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1073895439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102222",
            "address_2": "ATTN: CREDENTIALING DEPT.",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682222",
            "telephone_number": "239-274-8200",
            "fax_number": "239-278-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N US HIGHWAY 441 STE 540",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321598987",
            "telephone_number": "352-753-9777",
            "fax_number": "352-753-9781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAROTTA",
        "first_name": "ALEXZANDRIA",
        "middle_name": "DWAN",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-12",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9356337",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9356337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008358400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

Verify at the official NPI Registry.